Frozen Shoulder Physiotherapy Melbourne : Symptoms, Treatment & Recovery

Frozen shoulder is a condition where the shoulders become stiff and immobile because of thickened tissues surrounding the joint. This causes the formation of scar tissue in the capsule leading to severe pain and limited ROM.

Frozen shoulder can be managed with physiotherapy and, in most cases, full shoulder ROM can be achieved without the need for surgical intervention.

The recovery process for this condition can be lengthy, but with the right physiotherapy, significant improvement can be experienced in just 3 to 6 months despite the fact that physiotherapy is usually the only method employed to manage frozen shoulder during the 1 to 3 years that the condition can take to resolve on its own.

The condition is characterized by increasing shoulder pain and stiffness, limited shoulder ROM, and the inability to perform daily and most basic tasks such as dressing and reaching. Those impacted by the condition can also make it difficult to sleep.

Keep In Motion Physio provides frozen shoulder physiotherapy to those that live in the northern and western suburbs of Melbourne. From the early stages that are characterized by pain to the later stages of full rehabilitation, this guide will provide you everything you need to know about frozen shoulder physiotherapy in Melbourne.

What’s Frozen Shoulder?

This is an inflammatory condition which occurs not only on the glenohumeral joint but also on the connective tissue covering the joint. In frozen shoulder disease, there will be an inflammation and thickening of the connective tissue covering the joint, and because of this there will be fibrous adhesions developing on the joint capsule.

Frozen shoulder also differs from a rotator cuff injury or impingement in the pattern of limitation. With frozen shoulder, movement is restricted to the point of a mechanical limitation of the joint capsule. In the case of other shoulder conditions, movement is primarily restricted due to pain. People with frozen shoulder, even when put under, are unable to achieve a full range of motion, which is also what sets frozen shoulder apart.

Frozen shoulder affects an estimated 2 to 5 percent of the population, according to the Australian Physiotherapy Association. It is more frequent among women, individuals between the ages of 40 to 60 years old, and those with preexisting health conditions such as diabetes.

What Causes Frozen Shoulder?

Often, the shoulder seems to “freeze” on its own, and the reason is sometimes unknown. This is known as primary or idiopathic frozen shoulder. Still, several factors are thought to be related to the occurrence of frozen shoulder.

Diabetes

Diabetes can cause Frozen Shoulder and is usually a major factor. Frozen Shoulder affects 2-4 times the amount of individuals in the diabetic population. These individuals also experience increased and more severe symptoms, as well as an increased recovery time. There is no known reason as to why this is the case. Some speculate that problematic collagen metabolism and joint capsule glycation may be responsible.

Shoulder Injury, Trauma, or Surgery

Shoulder trauma or injury may be responsible for developing shoulder inflammation which can lead to Frozen Shoulder. An example of this would be a fall that leads to an arm injury, and sports injury treatment as well as a torn rotator cuff. This is known as secondary Frozen Shoulder.

Surgery or Prolonged Immobilisation

Frozen Shoulder can occur as a result of surgical procedures that require post-operative immobilisation of the arm for an extended time. This may include some cardiac and breast surgeries as well as some shoulder surgeries. This is one reason that post-operative shoulder therapy is initiated early.

Thyroid Disorders

Thyroid conditions may play an unexplained role in the development of Frozen Shoulder. Both hyper and hypothyroidism can increase the likelihood of developing Frozen Shoulder. If you have a thyroid condition, mention to your GP and Physiotherapist any shoulder pain or stiffness.

Age and Gender

Frozen Shoulder is typically seen in individuals 40-60 years of age. It is also seen, but not limited to, women, as it affects women twice as often as men. The reason for this disparity is not documented.

Long Periods of Not Moving

Anything that means not using an arm, like a stroke, broken arm, or surgery, means that the shoulder capsule can start to contract. This is the reason for the recommended early, gentle exercise with all patients who have sustained injuries or undergone surgery to the upper limb.

How to Identify Frozen Shoulder

Usually, the symptoms of frozen shoulder develop slowly and then start to improve after some time. Symptoms help to differentiate frozen shoulder and other shoulder problems.

• Pain: Shoulder pain with a constant dull pain at rest, but with a sharp pain at the extreme of the range of motion. Pain is often worse at night and can keep the person awake
• Stiffness: The shoulder becomes almost impossible to move over weeks to months. This is often first noticed with the inability to complete activities like reaching into a back pocket, or combing hair.
• A large reduction in range of motion: Painful and difficult to almost impossible to carry out the activities like reaching overhead to touch the ceiling or to rotate the arms out to the side.
• Difficulty dressing: Pain and difficulty to complete activities like reaching to the back to pull a shirt down or forward to pull a shirt over the head.
• Difficulty sleeping: Pain makes it impossible to sleep on the affected side and difficult to sleep on the other side.
• Referred pain: With frozen shoulder, pain spreads down the outer arm and towards the elbow. This can lead to mistaking the pain to be of a nerve origin.
• Muscle wasting and weakness: At the advanced stages, lack of shoulder use can lead to wasting of the deltoid and rotator cuff muscles.

Stages of Frozen Shoulder

The condition of frozen shoulder is self-limiting and has three distinct stages. Knowing the stage is important as the practice of Physiotherapy services needs to vary depending on the stage in order for the treatment to work effectively.

Stage 1 – The Freezing Stage (Duration: 2 – 9 Months)

This is the most painful stage. The shoulder is increasingly inflamed and the pain builds. It is often severe and at this stage it becomes difficult to fall asleep. The range of motion is reduced as the shoulder capsule begins to contract. During the pain of this stage, many patients are unable to pinpoint on their own the cause of the pain and this only adds to their distress. Physiotherapy at this stage is focused on the management of pain and the maintenance of gentle ranges of motion. It is important to avoid stretching of the shoulder to avoid inflammation worsening.

Stage 2 – The Frozen Stage (Duration 4 – 12 Months)

In this stage, there is a decrease in pain. But it is in this stage that stiffness is at its highest point. It is restricted in all possible directions. The shoulder feels locked into position. No wonder that this significantly affects the possibility of performing normal activities. The emulsification of looseness of the shoulder joint in this stage of treatment is the main issue of all looseness and is crucial in physiotherapy.

Stage 3 – Thawing Stage (5-26 Months)

The pain lessens more and more in this stage, and the range of motion comes back more as the body loosens up. This is also the stage where a lot of people see big progress. Spontaneous improvements still happen at this stage, but everyone is still a little different in how fast they improve. At this stage of the progression, physiotherapy is focused on strengthening, increasing range of motion, and rehabilitation. This stage is important for someone trying to get back to overhead motion, sports, and job activities.

 If physiotherapy is not received at this stage, the entire frozen shoulder cycle can take anywhere from 1-3 years. If someone receives proper physiotherapy during the earlier stages, they can expect a significant difference in how fast and how complete the recovery is.

How We Treat Frozen Shoulder Physio at Keep In Motion

To treat frozen shoulder at Keep In Motion Physio we adopt a staging system and only use evidence-based practices. Since frozen shoulder can present differently from person to person there is no single treatment that is universally effective. Treatment therefore varies according to the stage of the condition. Our clinics located in Craigieburn and Epping have frozen shoulder rehabilitation specialists who work with you from your first consultation until you have fully recovered.

1. Thorough Assessment

This first step involves a detailed assessment of your shoulder and its range of movement in all planes. The end feel of the motion is noted and the strength of the shoulder muscles is tested. Your posture is noted and the position of your cervical spine is evaluated. The results of this stage help identify the stage your condition is currently in and also helps to exclude the presence of any other shoulder pathologies. This assessment helps create the treatment strategy.

2. Joint Mobilisation

Mobilisation of frozen shoulder is one of the key techniques used in physiotherapy. Joint mobilisations that are graded and gentle help stretch the shoulder capsule and thereby begin to break the adhesions and improve the restricted range of movement. The stage of frozen shoulder that you have will determine the direction of the mobilisations.

3. Capsular Stretching

The frozen shoulder stretching techniques of posterior capsule stretches, sleeper stretches and cross body stretches are all directed at selected areas of the shoulder capsule. These stretches are done at the appropriate intensity for the stage. During the freezing stage the stretch is done with minimal force as a vigorous stretch could increase inflammation of the shoulder capsule. Conversely in the thawing stage, greater force is applied.

4. Builds Mobility

With the use of manual therapy and stretching as a basis, mobility exercises help progress the range of motion. These exercises begin with passive range of motion, such as the pendulum, assisted range of motion, and then full active range of motion. These mobility exercises reinforce the shoulder capsule and help facilitate the elasticity.

5. Dry Needling

Dry needling Melbourne can be used for upper trapezius and pectoral tightness as well as for guarding and knotted muscles of the rotator cuff. Since all of these muscles surround and protect the stiff shoulder joint, dry needling can help release these muscles and subsequently help reduce pain.

6. Pain Management

Pain becomes a management issue in the freezing stage of the process. We attend to pain through the use of several methods such as ultrasound, heat therapy, TENS, and dry needling. Your physiotherapist will also recommend medications to help maximize effectiveness of other therapies as well as ice and heat therapy and positioning techniques to enhance your sleep.

7. Strengthening

Once pain and range of motion have improved, shoulder strengthening activities begin. This program reinforces the strength of the rotator cuff and stabilizing muscles of the shoulder and scapula. This phase of therapy is important to help guard against weakness once a full range of motion has been achieved.

8. Hydrotherapy

Land-based exercises for the shoulder can be too painful for some patients in the early or middle phases of treatment. Hydrotherapy in Melbourne is a good alternative. The warmth of the water helps relax the shoulder, and the buoyancy of the water helps support the range of motion of the arm, pain and the water’s gravity, which makes some movements of the arm torturous on land.

9. Home Exercise Program

To recover from a frozen shoulder, it is important to have a structured home exercise program. You spend most of your time at home, and doing the proper exercises at home is very important for a speedy recovery. The physiotherapist will give you a specific program to do at home, and will change it at each session, based on how you are improving.

Best Exercises for Frozen Shoulder

Listed here are some of the exercises that physiotherapists most frequently prescribe for a frozen shoulder. It is important to have the physiotherapist evaluate you and determine what stage you are at and how you present, before you decide to do any of the exercises, as some of the exercises are contraindicated when you are in the freezing stage.

1. Pendulum Exercise

Stand beside a table and lean towards it using your healthy hand. Allow the affected arm to hang freely. Using a gentle swinging motion from your body (not the shoulder muscles), make small circles and forward-backward and side-to-side movements with the hanging arm. This gravity-assisted movement gently distracts the glenohumeral joint and reduces capsular compression. Perform for 1–2 minutes, 3 times daily.

2. Finger Walk

Stand in front of the wall and touch the wall with your fingers at waist level. Now slowly walk up and down the wall using your fingers. However, make sure that you do not go up too much; rather, just go as high as possible for you. The purpose of this exercise is to make shoulders more flexible without putting any pressure on the damaged part. Do this 10 times in a day.

3. Shoulder Cross-Body Stretch

This stretch will help in stretching the frozen shoulder. In this exercise, you should hold your affected arm near your chest and stretch it across your body using the other arm. The stretch will pull the arm across your body so that you feel a stretch at the back of your shoulder. You should do this for about 20 to 30 seconds. Repeat three times.

4. Wall Climb (Side)

Stand to the side of a wall with your affected arm closest to it. Place your fingertips on the wall at hip height and walk them up the wall. This exercise is meant to improve the upward reach of your arm, which is often difficult to do with a frozen shoulder. The key with this exercise, as with all of them, is to go slow and do your best not to force anything.

5. External Rotation Stretch

Lay on your back with your elbow bent at 90 degrees. Your upper arm should be be on the surface. Lower your forearm to the surface and let it hang. A stretch should be felt in the front of the shoulder. Hold the position for 20 to 30 seconds. External rotation is often the most limited movement for a frozen shoulder. It must be worked on in those cases.

How Long is the Recovery From Frozen Shoulder?

This is the main question that most patients have. It can be said that frozen shoulder can be one of the most tedious musculoskeletal issues to recover from. However, the recovery time can certainly be improved with physiotherapy.

Without Physiotherapy

The frozen shoulder can take anywhere from 1 to 3 years to resolve without any type of treatment. In that time, many patients do not regain full range of motion. Pain is very present during the freezing and frozen stages.

With Physiotherapy

Those who begin physiotherapy during the freezing or early frozen stages, will see substantial improvement in about 3 to 6 months. The majority will regain functional range of motion in about 6 to 12 months.

What to Expect

For the freezing stage, pain control and slowing the stiffness are the main goals of physiotherapy. Patients should expect to undergo at least 6 to 12 weeks of treatment before beginning to see substantial changes in range of motion.

• Frozen Stage: There is a considerable amount of active physiotherapy in this stage, and meaningful gains in range of motion require consistent treatment for 3-6 months.
• Thawing Stage: This stage brings an even faster recovery rate, and with the right physiotherapy, most patients reach a functional state of recovery within 3-6 months of entering this stage.

10 Tips to Recover Faster from Frozen Shoulder

1. Begin physiotherapy as early as possible: The sooner physiotherapy is commenced, the better the results of treatment become. Waiting to see whether the shoulder will thaw by itself is not an acceptable option.
2. Consistency with home exercises: Frozen shoulder recovery relies most on the consistency of home exercises, with daily, shorter exercise sessions preferred to longer, sporadic sessions.
3. Avoid severe pain: While stretching may cause some discomfort, significant sharp pain is an indication that you have gone too far and may be worsening the inflammation.
4. Utilize heat: Stretching becomes more comfortable and easier to perform after applying a heat pack to the shoulder for 10-15 minutes.
5. Select the proper sleep position: If sleeping on your back, support your arm in a comfortable position with a pillow. Do not sleep on your shoulder.
6. Stay active otherwise: Support mental well-being throughout the long recovery by maintaining overall fitness and cardiovascular health.
7. Rigid blood sugar control is essential for diabetics as blood sugar control is related to positive outcomes. It is important to collaborate closely with your General Practitioner or Endocrinologist during your recovery.
8. Anti-inflammatory medication during the freezing stage can help with inflamed capsular tissues and aid the effectiveness of physiotherapy. Be sure to discuss pain management with your GP.
9. Patience and realism should go hand in hand. A frozen shoulder will usually take several months to recover from. You should always remember that you should monitor any improvement in a continuous manner.
10. If your pain is extreme, consider a corticosteroid injection. In the early freezing stage of frozen shoulder, corticosteroid injections can reduce inflammation and improve the effectiveness of physiotherapy. This can be coordinated by your physio and GP.

Why Choose Keep In Motion Physiotherapy for Frozen Shoulder in Melbourne?

Treating a frozen shoulder is a clinical challenge that requires a dynamic, innovative treatment approach with a lot of patience. Our physiotherapy team at Keep In Motion has the required expertise to manage frozen shoulder at all levels and all stages of treatment, from control of the early pangs to the final stages of shoulder rehabilitation.

• Physiotherapists who are AHPRA-registered with specialism in shoulder problems and adhesive capsulitis
• Treatment plans tailored to each stage of frozen shoulder — every element of your plan will correspond to your position within the frozen shoulder cycle
• Techniques that are evidence-based such as Maitland joint mobilisation, capsular stretching to a specific end range, dry needling, and strengthening in a progressive manner
• Home exercise programs that are fully personalized and include progressions and consistent revisions
• Convenient locations — Clinics in Craigieburn, Epping, Wollert, Coolaroo and available morning and Saturday appointments
• WorkSafe, TAC, DVA, and Medicare EPC welcomed

Providing holistic care is important to us and we believe it is vital to treating the pain that accompanies long-term frozen shoulder. This is the neck and shoulder pain and chronic pain that is often felt and we address this in our practice.

FAQs

Keep in Motion Physiotherapy offers shoulder pain physiotherapy and treatment in Craigieburn, Epping, Wollert, Coolaroo, Roxburgh Park, Thomastown, and Truganina and other surrounding suburbs in the northern and western parts of Melbourne.